Pregnant Women and H1N1: Quebec Offers Preventive Leave

Pregnant women are not especially likely to catch novel influenza A (H1N1 or swine flu) say doctors, but those who do are at high risk of complications such as respiratory distress and pneumonia. While the virus doesn't cross the placenta, a woman's unborn baby can be delivered prematurely as a result of these complications, or she can miscarry. A number of pregnant women in Canada have died from H1N1 - two in Quebec. ("Pregnant women focus of H1N1 preparedness campaign")

Doctors are concerned about pregnant mothers choosing not to take the H1N1 vaccine when it becomes available. Only about 20% of these women get a seasonal flu shot. ("Pregnant women focus of H1N1 preparedness campaign") With the rush to get H1N1 vaccine, many feel there hasn't been sufficient time to test it for safety and side effects. Many worry about the connections with Guillain-Barré Syndrome (GBS,) a condition that has been associated in past with both seasonal flu and the 1976 swine flu vaccines. Although GBS is a rare condition, pregnant women should discuss the risks with their doctors. Both morbidity and mortality of GBS are higher in women who are pregnant. ("Guillain-Barré syndrome")

In Quebec program women whose work puts them at risk for whatever reason benefit from a special preventive maternity leave. This program - called "maternité sans danger" - is administered by the CSST, the province's workplace safety board and allows for women who cannot be reassigned to take time off work, without giving up any of their maternity leave. This program is already used by women whose work exposes them to dangerous chemicals, or who may come into contact with infectious diseases. Now teachers, daycare and hospital workers are able to take advantage of the special leave. While there is apparently a government directive in place recommending that school boards send pregnant staff on leave, there is some abiguity about who should and should not take advantage. Alain Poirier, national director of the Quebec Public Health Department, is quoted in a Gazette article as saying the leave should be applied, "not systematically, as in 'I'm a pregnant woman and a teacher,' but after a discussion with a doctor." ("Early maternity leave urged to lower H1N1 risk")

Quebec health authorities are recommending pregnant women get the H1N1 vaccine when it becomes available next month. Both the CDC and Health Canada similarly promote swine flu shots for pregnant women. It is also recommended that a pregnant woman and the people in her entourage follow other preventive measures such as handwashing and respiratory hygiene (i.e. covering a cough, sneezing into a sleeve) more stringently than the rest of the public. ("If You Are Pregnant")

Other H1N1 precautions for pregnant women include asking for an advance prescription for Tamiflu or Relenza, to be filled only if flu symptoms should arise. ("Pregnant women focus of H1N1 preparedness campaign") This allows a woman to receive prompt treatment for influenza, without having to undergo a very long emergency room wait, and without putting other pregnant women at risk. Any woman who fills the prescription should notify her doctor and follow up at the next visit.

Pregnant women are among those at priority to receive the H1N1 vaccine when it becomes available next month. Vaccination is voluntary and will be distributed free of charge to all Quebec residents. No details have yet been announced as to where or when the vaccines will be given. The province's health and social service networks says only "Québec has set up a program for influenza A(H1N1) immunization clinics, ensuring that the vaccine will be free for all Quebecers." ("Questions and answers about influenza A(H1N1)")

An adult who has symptoms of severe influenza should go immediately to the hospital. These include: trouble breathing, blue or grey lips, pain in the chest or stomach, dizziness or confusion, dehydration or much reduced urine output, severe vomiting and seizures. It is also advisable to seek medical help if the flu gets better then returns again, especially if the cough is worse or there is a fever. ("H1N1 flu (swine flu)")

Sources:

"Early maternity leave urged to lower H1N1 risk" Aaron Derfel (Gazette)

"Guillain-Barré syndrome" Wikipedia

"H1N1 flu (swine flu)" Lung Association

"If You Are Pregnant" McGill Health and Wellness

"Pregnant women focus of H1N1 preparedness campaign" Sharon Kirkey (CanWest News)

"Questions and answers about influenza A(H1N1)" Santé et Services sociaux Québec